From Diagnosis to Dialysis: When to Start Treatment for Kidney Disease?

The kidneys play a vital role in keeping the body balanced and healthy, yet their importance is often overlooked until something goes wrong. When kidney disease develops, it can be a life-altering experience that brings uncertainty and concern. Knowing what treatments are available can help you make informed decisions, improve your quality of life, and feel empowered in your health journey.

Can Damaged Kidneys Be Cured? 

Kidney disease can be divided into acute and chronic.

Acute kidney disease can have many causes, but once treated, the kidneys can restore normal function with minimal damage.

However, chronic kidney disease is a progressive condition, which means that once damage to the kidneys occurs, it typically cannot be reversed. If a damaged kidney is not protected, its function will likely decline over time. To be considered chronic, it must persist for at least three months.

This is because the kidneys are made up of 200,000 to over 2.5 million filtering units called nephrons. When nephrons are damaged, they don’t regenerate or heal like some other tissues in the body. Instead, the damage accumulates over time, reducing the kidneys’ ability to filter waste and balance fluids and electrolytes. 

While current medical treatments can help manage symptoms and slow the disease progression, there is no cure that can restore the kidneys to their original, healthy state once significant damage has occurred. This is why early detection, proper management, and understanding of treatment options are so critical.

How is Kidney Disease Staged? 

To understand the treatments for kidney disease, the most important step is knowing how it is staged. Staging helps ensure timely and targeted care, potentially slowing disease progression and improving quality of life.

Understanding KDIGO Staging for Chronic Kidney Disease (CKD)

The KDIGO guidelines (Kidney Disease: Improving Global Outcomes) provide a comprehensive system for staging chronic kidney disease. This system is based on two key measures:

1. Estimated Glomerular Filtration Rate (eGFR) – how well the kidneys are filtering waste. It is measured with a simple lab test and the patient’s age, sex and race. The result shows how much blood is filtered per minute through the kidneys.  

2. Albuminuria – albumin is a large protein that under normal circumstances can’t leak through the kidney’s filtration system, when albumin is found in urine it indicates kidney damage.

Together, these two parameters help determine the severity and risk of progression of CKD.

Image from: KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) Volume 105, Issue 4S, April 2024. 
www.kidney-international.org

Treatment Goals for Kidney Disease 

The main goal is to prevent further damage and slow the progression of the disease. This is why conditions that contribute to the progression of CKD, including hypertension, proteinuria, metabolic acidosis, diabetes, and abnormally high levels of lipids in the blood, such as high cholesterol, should be addressed. 

Adjusting the dose of medications, such as chemotherapy, vitamin supplements, treatments for hypertension, and even antibiotics, is sometimes required, as some of them are filtered through the kidneys.  

Having the support of a registered nutritionist on your team can help you achieve a nutritious diet and control your sodium and sugar intake. You can read more about nutrition in chronic kidney disease here. Or join the upcoming webinar Optimizing Kidney Health with Plant-Focused Nutrition: A Guide for Myeloma Patients, where you’ll learn new nutrition strategies to boost your health.  Click the button below to register for this free webinar. 

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When Is It Time to Start Kidney Replacement Therapy?

As chronic kidney disease progresses, the kidneys gradually lose their ability to filter waste, balance fluids and electrolytes, and regulate blood pressure and hormones. In CKD stage 4, kidney function is severely decreased, with an estimated glomerular filtration rate (eGFR) between 15 and 29 mL/min/1.73m².

At this stage, the kidneys are working at less than 30% of their normal function, and waste products can start to build up in the blood. Many patients begin to experience more noticeable symptoms like:

• Fatigue
• Swelling (edema)
• Loss of appetite
• Nausea
• Difficulty concentrating
• High blood pressure that's hard to control

Because of the significant decline in kidney function, it’s important to start preparing for the possibility of renal replacement therapy, which includes treatments like dialysis or kidney transplantation.

What Is Renal Replacement Therapy?

Renal replacement therapy includes treatments that replace the kidneys' filtration abilities.

While this may not be needed right away in stage 4, it is the ideal time to begin discussions and planning with your healthcare team, which may also expand if you include a nephrologist (kidney specialist). Preparing early can help:

• Avoid emergencies when kidney failure starts affecting other organs (CKD stage 5)
• Choose the right treatment based on your lifestyle and health goals
• Ensure a smoother transition if dialysis is needed

What is the Role of Dialysis in Kidney Disease?

Dialysis helps filter the buildup of toxins, fluids, and proteins that accumulate in the body due to the kidneys losing their filtration abilities. There are two types of dialysis:

• Hemodialysis directly filters the blood with the help of a machine. First, a vascular access is created, and once it’s healed, it is used to access the circulation, draw blood through a catheter to the dialysis machine, and return it “clean” to the body. 

• Peritoneal dialysis: A catheter is placed in the peritoneum (a mucous layer that protects the intestines). This catheter inserts a special fluid preparation that removes waste and extra fluids. This can be performed at home.

Those who hesitate about starting renal replacement therapy can rely on the guidance of licensed medical professionals on conservative and palliative care. 

What Are The Indications To Start Dialysis?

Timely initiation of dialysis can help prevent serious, potentially life-threatening complications caused by the buildup of toxins and imbalances in the body due to poor kidney function. 

According to clinical guidelines, therapy should be considered when patients develop the following conditions due to kidney failure:

• Neurological symptoms due to excess urate in the blood, with signs like confusion, involuntary movements, or seizures
• Pericarditis, pleuritis, or cardiovascular abnormalities 
• Blood clotting disorders 
• Uncontrollable hypertension that doesn’t respond to diuretics
• Difficult to control acid-base and electrolyte abnormalities

The Importance of Support during CKD Treatment

Living with kidney disease can be challenging, but you don’t have to face it alone. Having the support of your loved ones, caregivers, and healthcare team can make a significant difference in how well you manage your symptoms and stay on track with your treatment. 

Clinical guidelines emphasize the importance of a holistic approach, which includes not only medical therapies, physical activity, and a balanced diet, but also emotional and social support. 

Making lifestyle changes and adjusting to treatment can feel overwhelming, and that's when having someone to talk to or lean on becomes especially important. Whether it’s sharing a concern with your doctor, leaning on a family member, or connecting with others who truly understand what you’re going through. 

We invite you to join our HealthTree Connect Group for Myeloma and Kidney Disease, where you can share your experiences, learn from others, and find encouragement every step of the way.

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Sources: 

• KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD)
• Chronic Kidney Disease NIH Overview